Single-minded bid for separate lives

Laleh and Ladan Bijani hope tomorrow's operation will mark the end of their "difficult path".

Twins Laleh and Ladan ask for the world's prayers as they anxiously await surgery tomorrow. By Mark Baker.

Laleh and Ladan Bijani tomorrow morning embark on the final leg of their perilous quest for separate lives - with a nervous prayer that will echo around the world among tens of thousands of people moved by their plight and their courage.

In a specially built theatre in Singapore's Raffles Hospital, an international team of 12 surgeons, eight anaesthetists, four radiologists and about 100 medical support staff will begin a marathon operation to separate the Iranian twin sisters who were born with individual bodies and brains but a shared skull.

"Both of us have started on this journey together and we hope that the operation will finally bring us to the end of this difficult path," the 29-year-old lawyers said this week.

"We are touched by all the cards and emails pouring in every day from people all over the world. Your kind gestures have brought much comfort to us as we anxiously wait for our surgery. We have been praying every day for our operation . . . Please pray for us."");document.write("

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In a surgical feat expected to take at least 48 hours, teams of specialists working in relay shifts will divide the women's skull, reconstruct the shared blood supply systems to their brains and close the opened cavities with grafted skin and muscle.

But while the world's first attempt to separate adult twins conjoined at the head has brought together some of the finest surgeons from the US, Europe and Asia - and preparations of military-style precision for the so-called Operation Hope - the doctors remain as nervous as the patients about the outcome.

Benjamin Carson, a renowned neuro-surgeon from Johns Hopkins University in Baltimore and the team's leading consultant, believes the chances are even that the operation will end in triumph or tragedy, with one or both of twins dying or being incapacitated.

"We don't have experience to go on, but I would give them a 50-50 chance," says Carson, who has successfully separated three pairs of twin children joined at the head.

Carson insists that despite the dangers - including the risks of infection, blood-clotting and bleeding, and the relative inability of adult brains to adapt to trauma - he and his colleagues are driven by a determination to succeed and the compelling ambition of the two young women to live the rest of their lives apart. "If I thought we weren't going to be successful, I wouldn't have agreed to it. We're hopeful that when they awaken and recover, they will still have the same intellectual function. We're gearing everything we are doing not just to survival but to full intellectual function."

Ladan and Laleh, who had searched in vain for years to find surgeons willing to separate them, came to Singapore last November after a team lead by local neuro-surgeon Keith Goh successfully separated Nepalese infant twins conjoined at the head.

After months of medical and psychological tests, Goh reluctantly agreed to go ahead with the operation and began to assemble the international team of neuro-surgeons and plastic surgeons, all of whom are donating their time and skills.

"We were trying to convince the girls not to go ahead, actually," Goh told The Age. "It would have been the easiest thing in the world if they had said: 'OK, we don't accept the risk, thanks for the holiday'. But we just couldn't shake them."

The operation will be performed using a custom-built table on which the twins will be in a seated position. The theatre has been equipped with special heart monitors and a computerised image-guidance system to track the intricate surgical procedures.

Although there is no fusion of the twins' brains, they share significant vascular structures including the sagittal sinus, the principal blood-drainage system. In perhaps the most challenging part of the operation, the surgeons will give the vein to one twin and then try to create an alternative drainage mechanism for the other twin.

The plastic surgeons face an equally daunting task in closing the separated skull cavities of both women with grafted skin and muscle - a temporary measure pending the eventual insertion of plates.

Despite the obvious dangers, Ladan and Laleh are unshaken in their belief that the rewards of success far outweigh the risks of failure.

At a news conference last month, they spoke of the frustrations of being forced to share every moment of their lives and their inability to pursue separate careers and interests. "When we first opened our eyes to see the light, we wanted to be separated. We are now almost 30 years old. That is enough," said Ladan.